Most Doctors Know Basically Nothing About E-Cigarettes

New study suggests about half of all doctors think e-cigarettes are safe—while the other half think that's ridiculous

Aug 30, 2016 at 12:49 PM ET

We’ve seen a handful of studies on e-cigarettes, but the jury is still out on their long-term effects. Are vapes important smoking cessation tools? Dangerous gateway drugs for teens? Lung disease waiting to happen? Doctors still aren’t sure, according to a new study in the American Journal of Preventive Medicine. Out of 500 physicians studied, the odds were nearly 50-50 that a given doctor would tell his or her patient that e-cigarettes were either good or bad.

“We were curious about actual provider behavior — the advice doctors gave in real patient interactions,” said coauthor Judith Prochaska of Stanford Prevention Research Center, in a statement. “Within a novel online medical forum, we were able to observe the exact advice doctors were giving patients and see how that advice varied by topic and clinician.”

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The Centers for Disease Control and Prevention estimate that nearly 5 percent of adults in the United States use e-cigarettes regularly, and that many more take a casual vape. In theory, e-cigarettes are safer than conventional cigarettes because, rather than sucking on addictive nicotine while inhaling burning tobacco, the electronic version heats more innocuous liquid until it vaporizes.

But so far, scientists have yet to prove that e-cigarettes are safe or effective smoking cessation tools. “There’s been rapid growth in the promotion and use of the products without an evidence base in terms of their safety and efficacy for tobacco cessation,” Prochaska says. Doctors may be partly to blame for these misconceptions. To that effect, Prochaska and her team searched through anonymous questions posted on HealthTap, where users can submit their medical questions to a team of 72,000 licensed physicians, and identified 500 questions about e-cigarettes.

One would hope that the 72,000 doctors on HealthTap would have followed the evidence base — cautioning their patients against e-cigarette use until more studies have been conducted and certainly not supporting the unproven notion that vaping can help tobacco smokers quit.

But instead, Prochaska and her colleagues found that doctors more or less answered randomly. When patients asked about the safety of e-cigarettes, for instance, 47 percent of doctors on the site discouraged their use while 20 percent encouraged vapers to keep on vaping. But neither approach is backed by evidence — because we do not yet know whether or not e-cigarettes are safe. And when asked about using e-cigarettes to quit smoking, 54 percent of physicians suggested trying e-cigarettes. “The existing research, however, does not indicate that e-cigarettes help people quit combustible cigarettes,” Prochaska says. “This is an area in need of greater study.”

In light of these findings, researchers are working hard to educate doctors about how to how little we actually know about e-cigarettes. Prochaska and colleagues have already established an education portal online, which offers doctors continuing medical education credits for reviewing the science behind e-cigarettes. Meanwhile, at least one surprising finding from the study could help all physicians speak to their patients about e-cigarettes. The researchers found that, when doctors spoke about vaping in a positive light, their answers received higher reviews on HealthTap.

“That finding is really interesting in thinking about how physicians might best connect with their patients,” said coauthor Cati Brown-Johnson, in a statement. “Doctors might consider conveying their information about e-cigarettes in a non-judgmental way, even when conveying the risks.”